回收式自体输血联合控制性降压在脊柱外科内固定手术中的应用

Study on the application of autologous blood transfusion combined with controlled hypotension in spinal surgical internal fixation

目的探讨回收式自体输血联合控制性降压在脊柱外科内固定手术中的应用价值。方法选取2018年1月—2019年12月在百色市人民医院脊柱骨病外科住院行内固定手术的患者103例,将术中进行控制性降压,术中或术后采用异体输血的50例患者作为对照组,另外采用回收式自体输血联合控制性降压的53例患者作为治疗组。记录并比较两组术前术后血常规、凝血功能相关指标及出血量和回输血量情况。结果治疗组患者手术前后血常规相关指标(WBC、RBC、HCT及HGB)差异均有统计学意义(P<0.01);而手术前后凝血功能相关指标中FIB差异无统计学意义(P>0.05),PT和APTT差异有统计学意义(P<0.05)。手术前,两组WBC、RBC、HCT、HGB、PT比较差异均有统计学意义(P<0.05),而APTT和FIB比较差异无统计学意义(P>0.05);手术后,两组HCT、PT、APTT比较差异有统计学意义(P<0.05),其余血常规指标及凝血功能指标差异均无统计学意义(P>0.05);治疗组手术前后RBC、HCT、HGB、PT、FIB变化差值大于对照组,WBC变化差值小于对照组,差异有统计学意义(P<0.05),而APTT变化差值差异无统计学意义(P>0.05)。两组患者术中出血量比较,差异无统计学意义(P>0.05);治疗组患者平均回输血量为(523.40±306.60)mL;两组患者输注血浆和浓缩RBC量比较,差异有统计学意义(P<0.05)。结论脊柱外科内固定手术采用自体血液回输,术中采用降压药将血压控制在一定安全范围,术后临床观察效果显著,方法安全、可靠。

Objective To explore the application value of autologous blood transfusion combined with controlled hypotension in spinal surgical internal fixation.Methods 103 patients underwent spinal surgical internal fixation in Department of Spinal Osteopathic Surgery,People’s Hospital of Baise from January 2018 to December 2019 were selected;50 of them who underwent intraoperative controlled hypotension combined with allogeneic blood transfusion during and after operation were selected as the control group,and the rest 53 patients underwent autologous blood transfusion combined with controlled hypotension as the treatment group.The blood routine,coagulation function related indexes,bleeding volume and transfusion volume before and after operation were recorded and compared between the two groups.Results Within the treatment group,the differences in blood routine related indexes(WBC,RBC,HCT and HGB)before and after operation were statistically significant(P<0.01);while there was no statistically significant difference in FIB in coagulation function related indexes before and after operation(P>0.05),the differences in PT and APTT were statistically significant(P<0.05).Before operation,the differences in WBC,RBC,HCT,HGB and PT between the two groups were all statistically significant(P<0.05),but the differences in APTT and FIB between them were not statistically significant(P>0.05);after operation,the differences in HCT,PT,and APTT between the two groups were statistically significant(P<0.05),and the differences in other blood routine indexes and coagulation function indexes were not statistically significant(P>0.05).The changes in RBC,HCT,HGB,PT and FIB before and after operation in the treatment group were greater than those in the control group,and the change in WBC in the treatment group was smaller than that in the control group,which were statistically significant different(P<0.05);but the changes in APTT between the two groups were not statistically significant(P>0.05).There was no statistically significant difference in the intraoperative bleeding volume between the two groups(P>0.05).The average volume of blood transfusion in the treatment group was(523.40±306.60)mL;there was statistically significant difference in the amount of plasma infusion and concentrated RBC between the two groups(P<0.05).Conclusion The autologous blood transfusion combined with intraoperative use of antihypertensive drugs to control blood pressure within a safe range in spinal surgical internal fixation shows a remarkable postoperative clinical effect,and it is a safe and reliable method.